What men know about testosterone is highly influenced by media, especially since the FDA allowed direct-to-consumer advertising for prescription medications 22 years ago. You’ve seen the ads: Falling asleep after dinner? Sex drive down? Enjoying life less than before? Work performance tanking? Gotta be testosterone, right?
Alas, the answers to those questions really aren’t as simple as advertisers might lead you to believe. True here as much as with the rest of medicine, issues around testosterone get a little more complicated as you drill down deeper. Think of it as a ‘tip of the iceberg’ problem in which there’s a lot more to it than what’s obvious at first glance.
Here are 5 questions to ask yourself – and your doctor – when considering testosterone therapy. Consider it a guiding light as you navigate this uneven path.
1. Is your T truly low? T levels vary like ocean tides. So, along with your physical symptoms, your doctor will need at least two morning testosterone levels to make the diagnosis.
2. Is something else going on? None of the low T symptoms you hear about are specific just to low T. Up to a dozen other fairly serious medical illnesses can mimic low T symptoms. Do your body good and make sure that your medical provider has ruled out other reasons for feeling the way you feel.
3. Why is your T low? Testosterone levels can fall because the testicle is not doing its job…or because it’s not being told to do its job. Maybe the engine isn’t running because the gas tank is empty. This is an important distinction, with real implications for treatment, so make sure your doctor explores the “why” before treating your low T.
4. Can you boost your T? If the testicle can’t make enough T, then you need testosterone. But, if the testicle is sitting idle without enough gas, there’s much that you can do to improve things without prescription medication. For example, good sleep hygiene, weight loss, and stress reduction are excellent ways to naturally boost testosterone levels.
5. Am I ready for lifelong treatment? Testosterone replacement shuts down the body’s natural testosterone production, shrinks testicles, and results in male infertility. Its effects on the heart, blood clots and strokes are hotly debated. Data on increased longevity with testosterone is as scarce as polar bears in Paraguay. And, at some point, maybe 5-10 years into treatment, testicles will never recover the glory of their former selves if you decide to stop. Only you can decide if this is worth it.
In the words of Rwandan author Habyarimana: “Opportunity and risk come in pairs.” So true with the double-edged sword of testosterone.